Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    Plasma Dosage

    Doses plasma for transfusion in patients with active bleeding.
    Favorite

    IMPORTANT

    This dosing tool is intended to assist with calculation, not to provide comprehensive or definitive transfusion information. Always double-check dosing of any drug and consult a pharmacist or clinical pathologist as necessary.

    INSTRUCTIONS

    Absolute contraindications to transfusion of fresh frozen plasma (FFP): documented intolerance to plasma or components, congenital IgA deficiency with anti-IgA antibodies, etc. Relative contraindications: heart failure, pulmonary edema, etc. Plasma should be ABO-compatible with recipient.

    When to Use
    Pearls/Pitfalls
    • Use to correct deficiencies of clotting factors, for which a specific concentrate is not available, in patients with active bleeding.
    • Inappropriate indications include transfusion in patients without active bleeding or invasive procedures, correction of minimal elevations in INR (i.e., INR <1.7), expansion of circulatory volume, hypoproteinemia, correction of immune deficiencies, transfusion for nutritional purposes, correction of congenital or acquired deficiencies of clotting factors in the absence of hemorrhage, or correction of disorders of hemostasis in patients with chronic liver disease who are not bleeding.
    • Transfusion of less than the therapeutic dose of plasma should be discouraged.  
    • Plasma should be infused as soon as possible after it is thawed and never be refrozen.  
    • Precise prediction of the amount of plasma needed to be transfused to correct a particular coagulopathy is not currently possible. Thus, post-transfusion repetition of the coagulation test that prompted the transfusion is warranted.
    lbs
    mL/kg
    mL

    Result:

    Please fill out required fields.

    Next Steps
    Evidence

    Advice

    • Adverse reactions to the transfusion of FFP include:
      • Allergic reactions:
        • Mild (urticaria): occur in 1% of patients.
        • Severe and anaphylactic: occur with a frequency of <1 case per 100,000 transfusions. Risk for this complication may be reduced by using plasma from male donors who have never been transfused and from nulliparous female donors who have never been transfused, or by using solvent/detergent (S/D) FFP.
      • Transfusion-related acute lung injury (non-cardiogenic pulmonary edema developing within 4–6 hours of the transfusion of FFP). As with anaphylaxis (above), risk may be reduced by using plasma from male or nulliparous female donors who have never been transfused or by using S/D FFP.
      • Febrile reactions: occur in <1% of patients transfused with FFP and in up to 10% of patients undergoing plasma exchange.
      • Citrate toxicity: can occur after the rapid transfusion of large volumes of plasma and is particularly important in neonates and in patients with liver disease.
      • Transmission of infections: the process of freezing inactivates bacteria. Bacterial contamination and growth with release of endotoxins before freezing is extremely improbable. There is, however, still minimal risk of transmission of viral infections or infections due to other unknown or untested pathogens.
      • Circulatory overload: can occur, particularly in patients with renal or cardiorespiratory failure.
      • Inhibitors against deficient proteins: can develop after transfusion of plasma in patients with severe deficiencies of clotting factors.
      • Graft-versus-host disease (GvHD): no known cases of FFP-associated GvHD have been reported. Freezing causes lysis of lymphocytes, so irradiation of the plasma is not necessary.

    Formula

    Total plasma dosage, mL = desired plasma dosage, mL/kg × weight, kg

    Note the following:

    • Desired plasma dosage ranges from 10 to 20 mL/kg.
    • This dose is expected to increase the level of coagulation factors by 20% immediately after infusion.
    • A recommended standard dose of FFP is 10 mL/kg, but doses up to 15 or 20 mL/kg may be justified based on the clinical situation.
    Content Contributors
    Content Contributors